Your bladder is a sac-like organ that stores urine. It sits right next to your vagina. When the wall between the urinary bladder and the vagina weakens, the bladder may drop or sag into the vagina. This disorder is called a cystocele (a fallen bladder, or anterior prolapse of the vaginal wall).
It is a fairly common condition, affecting about 50% of people who give birth. It also happens to be the most common form of pelvic organ prolapse.
Grades of cystoceles
Grade 1: Mild. The prolapsed bladder drops only a short way into the vagina.
Grade 2: Severe. The bladder has sunk into the vagina and reaches the vaginal opening.
Grade 3: Advanced. The bladder bulges out through the opening of the vagina.
Contact your provider for a proper diagnosis
A prolapsed bladder can be uncomfortable, but is rarely painful. In some cases, it can lead to bladder infections.
If you experience signs or symptoms that impede your daily activity, it is important to contact your healthcare provider.
Causes of cystocele
The pelvic organs – the bladder, uterus, and intestines – are held in place by connective tissues and muscles in the pelvic floor. When the pelvic floor gets too weak or experiences excess pressure, anterior prolapse or cystocele can occur. This kind of pelvic organ prolapse can happen due to a variety of problems, including:
- Advancing age.
- Being overweight.
- Chronic cough or bronchitis.
- Chronic constipation.
- Family history of prolapse or weak pelvic muscles.
- Heavy lifting.
- Previous pelvic surgery, such as a hysterectomy.
- Repeated straining during bowel movements.
- Straining muscles during childbirth, which can cause a vaginal prolapse.
- Vaginal childbirth.
- Weak muscles around the vagina caused by lack of estrogen after menopause.
Symptoms of cystocele
Symptoms of cystocele are most notable after long periods of standing and may go away when you lie down.
These symptoms include:
- Aching or a feeling of pressure in the lower belly or pelvis.
- Bleeding from the exposed skin.
- Bulge in the vagina that you can feel, caused by the bladder pushing out of the vaginal opening in severe cases.
- Feeling of pelvic heaviness or fullness.
- Feeling that something has dropped out of your vagina.
- Frequent urinary tract infections.
- Incomplete emptying of the bladder.
- Lower back pain.
- Need to urinate often or urgently, especially after strenuous activity (stress incontinence).
- Needing to push organs back up into the vagina to empty the bladder or have a bowel movement.
- Pain during sex.
- Pelvic pressure that gets worse with standing, lifting, or coughing or over time.
- Problems putting in tampons or vaginal applicators.
- Urine leakage (urinary incontinence).
A prolapsed bladder can be uncomfortable, but is rarely painful. In some cases, it can lead to bladder infections. If you have any signs or symptoms that impede your daily activity, it is important to contact your healthcare provider.
To diagnose cystocele, your healthcare provider will review your medical history and do a physical exam.
Other tests may include:
- Cystourethrogram (voiding cystogram). This is an X-ray of the bladder taken while you are urinating with the bladder and urethra filled with contrast dye. It shows the shape of your bladder and any blockages, malformations, tumors, or stones in the bladder or urethra.
- MRI (Magnetic Resonance Imaging). This test creates detailed images of the inside of your body to determine the extent of bladder prolapse.
- Pelvic exam. While lying down or possibly standing, your doctor will examine the tissues of your vaginal wall, as well as your vagina for a tissue bulge that may indicate pelvic organ prolapse. You may be asked to bear down or simulate a bowel movement to see how much the prolapse is affected. You may be asked to contract your pelvic floor muscles as if you are trying to stop a stream of urine to check your pelvic strength.
- Urodynamics. This is a test of bladder function. It shows how much urine the bladder holds before causing an urge to void (urinate). It shows the cause of urinary incontinence. You may also have to do a urine test to check for signs of a bladder infection.
Other tests may be needed to find out if there are any problems in the other areas of the urinary system.
It is possible to treat cystocele, but treatment options vary based on the grade and severity of your prolapse.
The following remedies for mild or moderate cystocele include:
- Activity changes: Avoid certain strenuous activities, such as heavy lifting or straining during bowel movements, which can exacerbate the condition.
- Lifestyle changes: Eating high-fiber foods can help ease constipation associated with cystocele, and eating a healthy diet with exercise for weight loss may improve your condition.
- Kegel exercises: Regular, daily pelvic floor exercises can strengthen the muscles of the pelvis and the connective tissue, such as the vaginal wall, provide better bladder support, and prevent further pelvic prolapse. Your healthcare provider or physical therapist will instruct you how to do the exercises. Kegels are most successful at relieving symptoms with reinforced biofeedback, which uses monitoring devices to ensure the proper muscles are being tightened most effectively. Pelvic exercise will not decrease the size of the prolapse, but may help improve your symptoms.
The following medical treatments for more severe cystocele include:
- Cystocele repair surgery (anterior colporrhaphy). Cystocele repair is a vaginal operation that lifts the prolapsed bladder back into a more normal position with stitches. Excess vaginal tissue may be removed, or a tissue graft may be used to reinforce the vaginal tissue to increase support (known as vaginal repair). Cystocele repair is a major surgical treatment, requiring about two days in the hospital. However you will be able to resume normal activity in about 6 weeks.
- Hormone replacement therapy. If your cystocele is caused by a hormonal imbalance, hormone therapy may help strengthen the pelvic muscles, notably the vagina and bladder.
- Hysterectomy. Sometimes, cystocele is associated with uterine prolapse, which means your uterus sags out of position. If you have a uterine prolapse, your doctor may recommend surgically removing your uterus (hysterectomy) as well as repairing the damaged pelvic floor muscles, ligaments, and other tissues.
- Urethral suspension. If you have urinary incontinence related to anterior prolapse – specifically stress urinary incontinence or leakage during strenuous activity – you may need a procedure to support the urethra to ease the symptoms of incontinence. This procedure treats urethral prolapse.
- Vaginal pessary. A pessary is a plastic or rubber ring inserted into the vagina to support and hold the bladder in place. A pessary does not cure the prolapse, but can help relieve symptoms. Your doctor will fit the pessary for your vagina and show you proper cleaning and insertion techniques. A vaginal pessary is often used as a temporary alternative to surgery, or when the risk of surgery is too high, especially for pregnant people.
The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Cystocele (https://www.niddk.nih.gov/health-information/urologic-diseases/cystocele)
Urology Care Foundation. Bladder Prolapse (Cystocele) (https://www.urologyhealth.org/urology-a-z/b/bladder-prolapse-(cystocele))